Publication as Patient

I was in my office perusing patient records when I got the call. I’d been selected to be the new Physician Editor of The Hospitalist. I felt surprised—and excited. Then, harsh reality set in: My first deadline was only three weeks away. I checked my pulse—117 and irregularly irregular, good. I brewed some foxglove tea, chewed on some willow bark, and prepared to work.

Deja Vu

I found myself experiencing an unusual sensation. What was the emotion I was feeling? A fine mixture of dread and excitement, with an overlay of angst. I’d had this sensation before, but when?

I looked at the May issue of The Hospitalist. How was I going to continue to produce a quality publication—and improve upon it? The people who had supported my selection as editor were counting on me; my mom was counting on me. Heck, even I was even counting on me.

I drew a blank. Where would I go with this? That’s when it hit me: the sense of being in a situation that I wanted, only to discover I wasn’t ready. The tidal forces of time and pressure descended upon me.

In a flash I knew what was happening. I was suffering from delayed post-traumatic residency syndrome. It was 1985, and I was back in Houston’s old Ben Taub Hospital. (Reminiscing is a sure sign of early senescence.) I was the intern coming on service, a very busy general medicine service. Among my new patients, I had to pick up an elderly gentleman who had been ill for years and who had been in the hospital for more than a month. His chart was missing, he was unresponsive, and his family was AWOL.

My beeper kept going off. There was a code on the other side of the hospital, and the ED was calling. Should I give the patient heparin? How do I dose it? Should I give antibiotics and, if so, which ones? Should I draw blood cultures? My circuits totally overloaded.

My resident came to my rescue, with a cup of coffee and good advice: Settle down, find the old records, obtain a history, and perform a physical exam before I even thought about therapeutic intervention.

This was exactly what I needed to do as physician editor. I turned to my current resident-equivalent, in this case Lisa Dionne from John Wiley & Sons—the editorial Yang to my Yin. She gave me the same advice my resident had decades before: Get the back issues of The Hospitalist from SHM, see where it was going, where it had been, learn the terminology, and get organized. Luckily the SHM staff is a lot more responsive then the medical records department at Ben Taub was.

Then, as with any patient, I had to ask some basic questions. What initial symptoms caused the development of The Hospitalist? How long had the publication been present? What made it better, and what made it worse? Was it progressing or was it unchanged? Was I having chest pain? What was SHM, and why did it exist? What did a hospitalist want to read? What was a hospitalist, and why would anyone want to be one?

Why would anyone become a hospitalist? The most stimulating aspect I experience is the sensation that hospital medicine is an evolving field and there are hundreds of dedicated colleagues out there trying to make it better.